HomeMy WebLinkAbout0032 SKUNKNET ROAD - Health 32 SKUNKNET RD.
CENTERVILLE
A = 192 048 -
1
301�
�,. Town of Barnstable /
BAR'"AS& Regulatory Services
ArFa r,,o�a Richard Scali, Director
Public Health Division
Thomas McKean,Director „
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
January 2, 2019
Karen Zappula
32 Skunknet Road
Centerville, MA 02632
NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF
HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1
The property owned by you located at 32 Skunknet Road, Centerville, MA, was visited
on December 17, 2018 by Jim Parziale, R.S., Health Inspector. This visit a check up on
the ongoing cleanup effort of stock piled, water damaged items in the front and back yard
which has resulted in complaints filed with the Town of Barnstable Public Health
Division
The following violations of the Town of Barnstable Board of Health Regulations, Chapter
54 Building and Premises Maintenance were observed
§54-3 Outdoor Storage
Multiple items of trash and debris still remain on ground in front and back yard.
You are directed to correct the violation listed above by January 22,2019.
Please be advised that failure to comply with this order will automatically result in you
being required to appearance before the Board of Health at a public hearing on
January 22nd at 3:00 p.m.
PER ORDER OF HE BOARD OF HEALTH
as A. McKean,
Director of Public Health
Town of Barnstable
��, 2v
L✓� ^- "L S��k v�
Crocker, Sharon 1�)
I �
From: McKean, Thomas ,,�,�
Sent: Wednesday, November 28, 2018 4:34 PM
To: Crocker, Sharon
Subject: FW: pictures of 32 skunknet
Attachments: front yard jpg; backyard 1 jpg; backyard 2 jpg (�
Sharon
Please add this to the December agenda as an update to the Board- still not cleaned-up-See pictures of backyard.
From:Parziale, Jim
Sent: Wednesday, November 28, 2018 8:18 AM
To: McKean, Thomas
Subject: pictures of 32 skunknet
tom,
here are the photos of 32 skunknet. although it isn't perfect it is VASTLY better than before.The debris that remains is
almost completely screened from public view. and the old broke down car in the driveway has also been removed.
Jim Parziale
Town of Barnstable
Public Health Division
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oFr Town of Barnstable Barnstable
Board of Health
e.`i`aj
BMASS.nAB`�g 200 Main Street, Hyannis MA 02601
i679 �� 2007
Office: 508-862-4644 Paul Canniff,D.M.D. 'It;
FAX: 508-790-6304 John T.Norman
Donald Guadapoli,M.D.
July 19, 2018
Ms. Karen Zappula
32 Skunknet Road
Centerville, MA 02632
RE: Your Request for an Extension to Remove Piles of Indoor Household
Items Stored Outdoors on 'the Ground / 32 Skunknet Road Centerville
A = 192-048
Dear Ms. Zappula,
You are granted a four week extension, until August 14, 2918, to remove the
piles of indoor household items from your yard.
A broken water pipe caused a water leak inside your home at the end of
December 2017. Multiple piles of household items were then placed onto your
lawn outdoors. You stated contractors were hired but the restoration work
remains incomplete in the basement where items could be stored.
After enduring multiple months of multiple piles of furniture and other household
items in the yard, a large rusted metal storage container, and an abandoned
unregistered vehicle in the driveway, several neighbors submitted inquiries and
complaints to the Health Division.
During the hearing, two gentlemen from the Rotary Club of Hyannis offered
assistance. Both men provided you their contact information. The Health _
Division also offered limited financial assistance for the purpose of disposing_ of
unsalvageable items. A private .disposal company was contacted on July 18,
2018 to provide a cost estimate. The company will be authorized to begin the
clean-up work this week.
This extension is granted to.provide you the additional time you requested to hire
a contractor to finish the work in. the basement, to remove and dispose of the
Q:\Zappula 32 Skunknet Road Extension 2018.docx
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furniture/household items which cannot be salvaged, and to relocate any
salvageable items indoors.
All indoor household items must be removed from the yard on or before August
14, 2018.
PER ORDER OF HE BOARD OF HEALTH
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`Pau Ca
Chairman
Q:\Zappula 32 Skunknet Road Extension 2018.docx
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Paul L.Gandillot
MBA,Lean Six Sigma Black Belt
51 Coventry Lane
West Barnstable,MA
02668 J �
617-548-3463 L..J
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paulgandillot@yahoo.com- —.
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Parziale, Jim ,
From: KarenZappula <46teacher16@gmail.com>
Sent: Monday, July 9, 2018 11:23 PM
To: Parziale, Jim
Subject: Letter to Dr.Paul Caniff
32 Skunknet Rd.
Centerville,MA 02632
July 9, 2018
Dear Dr. Paul Caniff,
I am sending this letter via email in response to the complaint about household items that were put on my back
lawn at the above address by Oceanside Restoration from the end of December through March of this year after a pipe
burst in my baseboard heating.
After Christmas I had to move out my home because the water was shut off and Oceanside began the demolition
work on three rooms and a hallway.They emptied any wet contents onto the lawn. For the first 3 days they covered and
secured everything with a heavy white plastic.Then they stopped working.When they returned weeks later, they
haphazardly threw the basement contents into three piles, covering them with a flimsy clear plastic that was not
properly secured.This occurred over a three week period.They never returned to repair and restore the heating
system or to start restoration as they were told to do by the insurance company.Then the 4 Nor'easters occurred
followed by a rainy spring exposing the contents of the piles.
In March I hired a different contractor who restored the heating system and begin restoration.At the end of May I
was able to return to my home, as it was 90%finished on the main floor. I paid them for materials to restore the
basement room at the end of April, but they have not returned to do that work. I need that space to put things I am
salvaging from the outside.
As things stand now, I have a meeting scheduled this week with the second contractor to determine if he will finish
the basement . If not, I will have to find someone else to complete the work. I have also arranged for a trash company to
haul away on July 19 what is ready to be discarded.There are no food or perishable goods in the pile that exists on the
lawn. What remains is mostly furniture, shelving, boxes of clothing and books, decorations and kitchen items.So though
it is unsightly, I don't feel it poses a health hazard.
. I am anxious to return my,home to an acceptable condition.This has been a nightmare that has been both difficult
and frustrating for a 71 year old person who is
dealing with contractors who have not completed what they say they will do, while I try to work part time as well as
support a son who has MS and lives four hours away and to sort though what has been dumped on the lawn. I am
making progress, but will need another month to complete the work.
Sincerely,
Karen A. Zappula
1
I
Town of Barnstable
ffr"' Regulatory Services
1 ptp � Richard Scali,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
May 1, 2018
Karen Zappula
32 Skunknet Road
Centerville, MA 02632
NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF
HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1
The property owned by you located at 32 Skunknet Road, Centerville, MA, was visited
on April 30, 2018 by Jim Parziale, R.S., Health Inspector. This visit was in response to a
complaint filed with the Town of Barnstable Public Health Division
The following violations of the Town of Barnstable Board of Health Regulations, Chapter
54 Building and Premises Maintenance were observed
§54-3 Outdoor Storage
Large pile of household items observed in backyard.
You are directed to correct the violation listed above within fifteen (15) days of
receipt of this order letter.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Please be advised that failure to comply with an order will result in a fine of$100.00. Each
day's failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S.
Director of Public Health
Town of Barnstable
1 N
i
Parziale, Jim �~ f 10Ci
From: KarenZappula <46teacher16@gmail.com> ( 6oll
Sent: Monday,July 9, 2018 11:23 PM
To: Parziale, Jim
Subject: Letter to Dr.Paul Caniff
32 Skunknet Rd.
Centerville,MA 02632
July 9, 2018
Dear Dr. Paul Caniff,
I am sending this letter via email in response to the complaint about household items that were put on my back
lawn at the above address by Oceanside Restoration from the end of December through March of this year after a pipe
burst in my baseboard heating.
After Christmas I had to move out my home because the water was shut off and Oceanside began the demolition
work on three rooms and a hallway.They emptied any wet contents onto the lawn. For the first 3 days they covered and
secured everything with a heavy white plastic.Then they stopped working.When they returned weeks later, they
haphazardly threw the basement contents into three piles, covering them with a flimsy clear plastic that was not
properly secured.This occurred over a three week period.They never returned to repair and restore the heating
system or to start restoration as they were told to do by the insurance company. Then the 4 Nor'easters occurred
followed by a rainy spring exposing the contents of the piles.
In March I hired a different contractor who restored the heating system and begin restoration.At the end of May I
was able to return to my home,as it was 90%finished on the main floor. I paid them for materials to restore the
basement room at the end of April, but they have not returned to do that work. I need that space to put things I am
salvaging from the outside.
As things stand now, I have a meeting scheduled this week with the second contractor to determine if he will finish
the basement . If not, I will have to find someone else to complete the work. I have also arranged for a trash company to
haul away on July 19 what is ready to be discarded.There are no food or perishable goods in the pile that exists on the
lawn. What remains is mostly furniture, shelving, boxes of clothing and books, decorations and kitchen items.So though
it is unsightly, I don't feel it poses a health hazard.
I am anxious to return my-home to an acceptable condition.This has been a nightmare that has been both difficult
and frustrating for a 71 year old person who is
dealing with contractors who have not completed what they say they will do, while I try to work part time as well as
support a son who has MS and lives four hours away and to sort though what has been dumped on the lawn. I am
making progress, but will need another month to complete the work.
Sincerely,
Karen A. Zappula
1
Town of Barnstable
AM Regulatory Services
►639� `��
659. Richard Scali, Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
May. 1, 2018
Karen Zappula
32 Skunknet Road
Centerville, MA 02632
NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF
HEALTH REGULATIONS, NUISANCE CONTROL REGULATION NO. 1
The property owned by you located at 32 Skunknet Road, Centerville, MA, was visited
on April 30, 2018 by Jim Parziale, R.S., Health Inspector. This visit was in response to a
complaint filed with the Town of Barnstable Public Health Division
The following violations of the Town of Barnstable Board of Health Regulations, Chapter
54 Building and Premises Maintenance were observed
04-3 Outdoor StorajZe
Large pile of household items observed in backyard.
You are directed to correct the violation listed above within fifteen (15) days of
receipt of this order letter.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Please be advised that failure to comply with an order will result in a fine of$100.00. Each
day's failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S.
Director of Public Health
Town of Barnstable
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Town of Barnstable Barnstable
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Board of Health j edca j
B MAM`�g 200 Main I Street, Hyannis MA 02601 �.
1639.
0.�m 2007
Office: 508-862-4644 Paul Canniff,D.M.D.
FAX: 508-790-6304 John T.Norman
Donald Guadagnoli,.M.D.
July 19, 2018
Ms. Karen Zappula
32 Skunknet Road
Centerville, MA 02632
RE: Your Request for an Extension to Remove Piles of Indoor Household
Items Stored Outdoors on the Ground / 32 Skunknet Road Centerville
A = 192-048
Dear Ms. Zappula,
You are granted a four week extension, until August 14, 2918, to remove the
piles of indoor household items from your yard.
A broken water pipe caused a water leak inside your home at the end of
December 2017. Multiple piles of household items were then placed onto your
lawn outdoors. You stated contractors were hired but the restoration work
remains incomplete in the basement where items could be stored.
After enduring multiple months of multiple piles of furniture and other household
items in the yard, a large rusted metal storage container, and an abandoned
unregistered vehicle in the driveway, several neighbors submitted inquiries and
complaints to the Health Division.
During the hearing, two gentlemen from the Rotary Club of Hyannis offered
assistance. Both men provided you their contact information. The Health
Division also offered limited financial assistance for the purpose of disposing of
unsalvageable items. A private disposal company was contacted on July 18,
2018 to provide a cost estimate. The company will be authorized to begin.the
clean-up work this week.
This extension is granted to provide you the additional time you requested to hire
a contractor to finish the work in the basement, to remove and dispose of the
Q:\Zappula 32 Skunknet Road Extension 2018.docx
furniture/household items which cannot be salvaged, and to relocate any
salvageable items indoors.
All indoor household items must be removed from the yard on or before August
14, 2018.
PER ORDER OF HE BOARD OF HEALTH
('-7-)
P46 . CaV-V IN
Chairman
Q:\Zappula 32 Skunknet Road Extension 2018.docx
Parziale Jim 10(i
From: KarenZappula <46teacher16@gmail.com>
Sent: Monday, July 9, 2018 11:23 PM
To: Parziale,Jim
Subject: Letter to Dr.Paul Caniff
32 Skunknet Rd.
Centerville,MA 02632
July 9, 2018
Dear Dr. Paul Caniff,
I am sending this letter via email in response to the complaint about household items that were put on my back
lawn at the above address by Oceanside Restoration from the end of December through March of this year after a pipe
burst in my baseboard heating.
After Christmas I had to move out my home because the water was shut off and Oceanside began the demolition
work on three rooms and a hallway.They emptied any wet contents onto the lawn. For the first 3 days they covered and
secured everything with a heavy white plastic.Then they stopped working.When they returned weeks later, they
haphazardly threw the basement contents into three piles, covering them with a flimsy clear plastic that was not
properly secured.This occurred over a three week period.They never returned to repair and restore the heating
system or to start restoration as they were told to do by the insurance company.Then the 4 Nor'easters occurred
followed by a rainy spring exposing the contents of the piles.
In March I hired a different contractor who restored the heating system and begin restoration.At the end of May I
was able to return to my home, as it was 90%finished on the main floor. I paid them for materials to restore the
basement room at the end of April, but they have not returned to do that work. I need that space to put things I am
salvaging from the outside.
As things stand now, I have a meeting scheduled this week with the second contractor to determine if he will finish
the basement . If not, I will have to find someone else to complete the work. I have also arranged for a trash company to
haul away on July 19 what is ready to be discarded.There are no food or perishable goods in the pile that exists on the
lawn. What remains is mostly furniture, shelving, boxes of clothing and books, decorations and kitchen items. So though
it is unsightly, I don't feel it poses a health hazard.
I am anxious to return my-home to an acceptable condition.This has been a nightmare that has been both difficult
and frustrating for a 71 year old person who is
dealing with contractors who have not completed what they say they will do, while I try to work part time as well as
support a son who has MS and lives four hours away and to sort though what has been dumped on the lawn. I am
making progress, but will need another month to complete the work.
Sincerely,
Karen A.Zappula
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Town of Barnstable
LL ' Regulatory Services
Richard Scali,Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
May 1,2018
Karen Zappula
32 Skunknet Road
Centerville, MA 02632
NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF
HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1
The property owned by you located at 32 Skunknet Road, Centerville, MA, was visited
on April 30, 2018 by Jim Parziale, R.S., Health Inspector. This visit was in response to a
complaint filed with the Town of Barnstable Public Health Division
The following violations of the Town of Barnstable Board of Health Regulations, Chapter
54 Building and Premises Maintenance were observed
§54-3 Outdoor Storage
Large pile of household items observed in backyard.
You are directed to correct the violation listed above within fifteen (15) days of
receipt of this order letter.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Please be advised that failure to comply with an order will result in a fine of $100.00. Each
day's failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S.
Director of Public Health
Town of Barnstable
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4 Paul L.Gandillot
a ak' MBA,Lean Six Sigma Black Belt
51 Coventry Lane
West Barnstable,MA
02668
617-548-3463 �J
paulgandillot@yahoo.com
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TOWN OF BARNSTABLE
LOCATION 401de SEWAGE #
VILLAGE ASSESSORA MAP & LOT
IW A4!OA,NAME&PHO NO.10,, F l�)
SEPTIC TANK CAPACITY - /000
LEACHING FACIL=:.(type) (size) /0(��
NO. OF BEDROOMS
BUILDER R OWNER
a-
PERMTTDA : COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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998
BORTOLOTTI CONSTRUCTION, ON''a", �
765 WAKEBY ROAD,MARSTONS MILLS,MA. 026 �
508-771-9399 508428-8926 FAX: 508428-9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPv ,CTION FORM
PART A
CERTIFICATION
Property Address•
Date of Inspection: Inspector's Name:
er's Name and Address: `
V-0-g3O �A
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at thi.-:y address and that the informa-
tion reported below is true,accurate and complete as of the time of inspec�ior.:.The inspection was per-
formed based on my training and experience in the proper function and in.-iintenance of on-site sewage
disposal systems. The System:
Passes
Conditionally Pass
Needs Further E ation by hee L al Aproving Authority. b:
Fails 112Ar
Inspector's Signature: Date:
'The System Inspector shall submit a copy of this inspection report to the approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared systera o�has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to he appropriate regional
office of the Department of Environmental Protection. The original should F o'sent to the system owner
and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
A)SYSTEM PASSES:
e have not found any i:dera:aatioc:which indicates that the systc m violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria Riot evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or reparrul'.. The system,upon comple-
tion of the replacement or repair, passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determinatiod in all instances. If
"not determined",explain why not.
The septic tank is metal,cracked,structurally unsound,show::su ►.tantial infiltration or
exfiltration,or tank failure is imminent. The system will pi s i-vipection if the existing sep-
tic tank is replaced with a conforming septic tank as approvot t y The Board of Health.
Sewage backkup or breakout or high static water level obseni d is i the distribution box is due
to broken or obstructed pipe(s)or due to a broken,settled or w�.i en distribution box. The
system will pass inspection if(with approval of The Board o`
} 4 . 0
.D' l 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
,�. PART A
.CERTIFICATION (continued)
y Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
Broken pipe(s)are replaced
—Aruction is-removed
_£
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by The Board of Health in order,to determine if
the system is failing to protect the public health,safety and the environment.
1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE ,
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:-
"' Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IFAPPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN'A MANNER THAT PROTECT THE PUBLIC HEALTH,AND>SAFETY AND;THE
ENVIRONMENT:`
The gystem has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well,
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well, unless a well+water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
1/ I have determined that the system violates one or more of the followhig;failure criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health
she be contacted to determine what will be necessary to correct the Failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the'surface of the ground or surface waters due to an
overloaded or clogged SAS or cesspool.
Static liquid level.in the distribution box above outlet inve.rt.due,to an overloaded or
clog-ged SAS or cesspool.
Liquid depth_in.cessp ,ol,is less than 6"below inveh or avai dable v'olume is less than 1/2
t day flow.
Required pumping more.than 4..times in the,last year NOT:due�o clogged or obstructed
pipe(s), Number of times pumped
-2-
! r 1
SUBSURFACEVSEWAGE DISPOSAL SYSTEM INS'3 h1'_TION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 Feet of a priva!a Water_supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliforin'bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
• E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria ab*ve:
The design flow of a system is 10,000 gpd or greater(Large System).and the system is a significant
threat to public Health and safety and the'environment because one or more of the following
conditions exist:
t"
The system is within 400 Feet of a surface disking water sup)il,�
The,system is within 200 Feet of a tributary to a surface drinking watersupply
The system is located in a nitrogen sensitive area Interim Wellhead Protection Area,
(IWPA)or a mapped Zone 11 of a public water supply.weli.•
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local .
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
_j,:::fNmPing information was requested of the owner,occupant,and B cq ird of Health.
:�:�one of the system components have been pumped for atleast two woks and the system has
been receiving normal flow rates during that period. Large vol4na,*of water have not been
C' introduce&into the system recently or as part of this inspection.
✓As-built plans have been obtained and examined.-Note if they are not available with N/A.
=The facility or dwelling was inspected for signs of sewage back-up.
_U/The,system does not receive non-sanitary or industrial waste flow.
v, The site, was inspected for signs of breakout.
All system components,excluding the Soil Absorption System, lieu.+ seen located on site.
The septic tank manholes were uncovered,opened;and the intei:iior:af the septic tank was in
spected for condition of baffles or tees,material of construction,rd�riensions,depth of liquid,
epth of sludge,depth of scum.
he size and location of the Soil Absorption System oii the site ipis been determined based on
existing information or approximated by non-intrusive metho s:r .a ;
-3- �.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
VThe facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
FORM
INSPECTION
SYSTEM
SUBSURFACE SEWA
GE DISPOSAL
_ PART C
SYSTEM INFORMATION
/ FLOW CONDITIONS
Design Flow: allons Number of Bedrooms:, Nun ber of Current Residents:
Garbage Grinder: Laundry Connected To System: 17ea Seasonal user
Water Meter Readings,if AV ilabl
Last Date of Occupancy:
CO MFRCikLJiNDIISTRI_AL•
Type of Establishment:
Design Flow: n gallons/day, Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Dale of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information� _ '
_ - ,..
System Pped as part oI inspection:•.AYE It yes,volwne uinped:= - aailons
um
Reason for pumping:
TYPE OF SYSTEM:
Septic Tank/Distribution Box/Soil.Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,a ch previous inspection records,if any)
-'(0th ekplain): —
••
APPROXIMATE GE of all components,date installed(if known)and source of information:
n Sewageodgrs detected when arriving al,the site: e rt
_. _. -4-
SUBSURFACE SEWAGE DISPOSAL SYSTEM 1F&PECTION FORM
PART'C
GENERAL INFORMATION (continued)
SEPTIC TANK: w
Depth below grade: Material of Construction: concrete__-_►unetal FRP_Other
(exphtin)
Dimisions: Sludge Depth: Scum Thickness:
Distance from top of sludge to bottom of outlet tee or baffle: _.
Distance from bottom of scum to botloin of outlet tee or baffle:
Comments:(recommendation for pumping,condition of inlet and outlet tees;(:=r baffles,depth of liquid
level in relation to outlet invert,structural 'integrity,evidence of leakage,etc.)_
GREASE TRAP:
Depth Below Grade:: Material of Construction:_concreu-,- _atletal FRP_Other
(explain)
Dimensions: Scum Tliickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet 1,c5 or baBlbs,depth of liquid
level in relation to outlet invert;structural integrity,evidence of leakage;1-AG*.;t
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_concrete—mct:,ai-_.—FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow:__ �allons/day
Alarm Level:
m.'Coments: (conditi n of tnlel tee;condition of alarm and float switches ,;7 *".
DISTRIBUTION BOX:
Depth of liquid level above outlet invert: _
Comments: (note if level and distribution is equal,evidence of solids carEyov r,evidence of leakage into
or out of box,etc.)
PUMP CHAM&lk-.
Pump,is in working-order:
Comments:(note-condition of pump chamber,condition of pumps ;Fenances,.etc:)
U.
SUBSU.' ACE SE_WAGE DISPOSAL'SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan,if possible;excavation not required,but may be approxiihated by'non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits,number: Leaching chambers, number: Leaching gaileries,number:
Leaching trenches,number,length:
Leaching fields,number,diMn z2,mmz: __-
Overflow cesspool, number:
Comments:(note condition of soil signs of h draulic failu c level of riding, condition of vegeta ' n,
etc.) 2 -
CESSPOOLS:
Ntunber and configuration:/-�p �l'S Depth-top of liquid to inlet_invert,
Depth of solids layer: Depth of scum layer:` • DimenE-3ns.of Cesspool:
Materials of construction: " e" ndication of ground eY?.t..r:
hallow(cesspool must be pumped as part of inspection)
Comments:(note condition of soilk,signs of hydraulic fai re, level p�rn�in�;condition of ve talon,
etc.)
01
01
xIVY: eZp r
Materials of construction: Dimensions: ...
Depth of Solids:_ _
Comments:(note condition of soil,signs of hydraulic failure, level ofpop%ing,condition of vegetation,
e
etc.) _
0
1 L.'
-6-
SUBSURFACE SEWAGE DISPOSAL SYSTEM-Ifd131-. : TION FORM
PAWF C
SYSTEM INFORMATION (coMenve.d)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to adeast two permanent references, landmarks or benchin.riks.
Locate all wells within 100 Feet.
47, /,...
(09
a
DEPTH TO GROUNDWATER: /
Depth to groundwater: / Feet
Meth of Determinadon or Approximation:
-7-
TOWN OF BARNSTABLE
LOCATION 12 516VA16/1C d-� ' SEWAGE # +
VII.LAGE cz ASSESSOR'S MAP &LOT .
INSTALLER'S NAME&PHONE N0.
SEPTIC TANK CAPACITY 1,5 0& 5`
LEACHING FACILITY: (type) �.,�/1:' (size) r l y ;
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: _COMPLIANCE DATE: a
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet,of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
dG�iG ' a7 i3� -
TOWN OF BARNSTABLE
LOCATION 3.), 9 L SEWAGE#
VILLAG ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
! SEPTIC-TANK CAPACITY o�
LFA£HING FACILITY: (type) f.:/1 (size)
! NO,-.:.OP BEDROOMS__
BUMPER OR OWNER c. •�." p
PEI#IyII'TDATE: Z213r _COMPLIANCE DATE: d1. I Rom_
Sepaauon Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
P6:ate:Water Supply Welland Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge:ot*edand and Leaching Facility(If any wetlands exist
;within 300 feet of leaching facility) Feet
Furnished by
WWOW /
3
A3
, j
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
-
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpprication for 3W!5pozar *pstem Construction Permit
Application for a Permit to Construct( )Repair( -. Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No.-3 3L rJ vp-J Owner's Name,Address and Tel.No.
Assessor's Map/Parcel `1
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�06c,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3-3 4D gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. QC ctpGcTV�s' �f r ToQJ
Description of Soil iI e,Q—5 4y o
Nature of Repairs or Alterations(Answer when applicable) ST VO4�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Cod and not to place the system in operation until a Certifi-
cate of Compliance has bee Bo ff cc
Signed Date
Application Approved by Date
Application Disapproved for the o IA4 reasons
Permit No. Date Issued
No. _. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
21pplication for M!5po!af *pftem Conotruction Permit
Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 5)4v—Y_6.C'eC" Owner's Name,Address and Tel.No.
GCtA,-'rCVVi`� t�
Assessor's Map/Parcel t q 6` ? Y, CLVT%AreV
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�_092bC, C6eV--\-S
,L'
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
NO
,Other Type of Building No. of Persons Showers( ) Cafeteria( )
,Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
,
Title _
Size of Septic Tank Type of S.A.S.
Description of Soil VIA`e•a
Nature of Repairs or Alteratio�}s(Answer when applicable) . h►ST�-4\ 5��=714
'�- /(,�(r �-�,� C c L fw( � �c�,Z`✓Gtc,1LS cti� �{ SAC U� 07'� ,
Date last inspected:
<11,;Agreernent:
The undersigned agrees to ensure`the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Cod and not to place the system in operation until a Certifi-
cate oPCompliance has bee Bo ,c
r igned / Date _Cr
Application Approved by Date
Application Disapproved for the o low reasons
ti
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO C t�theAust�lewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by �
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No L-1 dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed;}
Date i ). '~- <- Inspector_
No. 4 f
Fee t
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
Mizpogal *p5tem Cougtruction Permit
Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( )
System located at N- Wa
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and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: — 7 ?T Approved by
i
1019197
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• This Form Is To Be Used For the Repair.Of Failed
NOTICE:
Septic Systems Only.
CERTIFICATI ON OF SKETCH AND APPLICATION FOR A
WORKS CONSTRUCTION PERMIT (WITHOUT
DISPOSALENGINEERED PLANS)
hereby certify that the application for disposal works
concerning the
construction permit signed by me dated
meets all of the
property located at `3� :
G ev".�'�
following criteria:
�'. There are no wetlands located within 100 feet of the proposed leaching facility
private wells within 150 feet of the proposed septic system
(/ There ere no pri
- / l
There is no Increase in flow and/or change in use proposed
4: There are no variances requested or needed.
lii If the proposed leaching facility will be located within 2
so feet of any wetlands,the bottom of the
}
ed leaching facility will 110 be lasted less than fourteen(14)feet above the maximum adjusted
gropos
ndwater table elevation.
please complete the following:
Engineering Division O.LS.map)
A)Top of Ground Elevation(according to the Engin g
observed Groundwater Table Elevation(according to Health Division well map)
DATE:
SIGNED
LICENSED SEPTIC SYSTEM IN ALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a alceteh plan of"plepoaad ayaMn.Also Ittha tleansad I"dollar pogemm a c*"Ifled plot plan,
this plan should be submitted].
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